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hiv transmission when viral load is undetectable
Dec 13, 2003

Dear David

I have often seen and heard the following question:

If a person's viral load is undetectable can that person infect someone else with HIV?

The answer is always rather vague and runs as follows:

'Even if a person's viral load is undetectable in the blood, they may still have concentrations of HIV in e.g. sperm and thus remain infectious'.

I'm concerned about the use of the word 'may'. It implies that it is not known whether there are still concentrations of HIV in the sperm of a person whose blood viral load is undectable. Surely it would be easy enough to screen the sperm of such a person and thus establish whether there is HIV in the sperm etc.

What are we actually saying here? Are scientists concerned that a viral rebound might go undetected initially, thus leading a person to unwittingly pass on the virus because he thought his undetectable status made him OK?

We need to know more about this.

Kevin

Response from Dr. Wohl

I actually don't really think we "need to know" more about this as much as you do. In medicine, as in love, there is no always and no never. There are too many variables: the amount of free and intracellular virus in genital secretions, inflammatory genital tract infections, the type of sex, the number of intercourse events, the gender of the partners, whether a female partner is menstruating, the susceptibility of the uninfected partner, etc, etc, etc.

The risk of transmission certainly goes down as the viral load falls but does it go to zero? It depends on so many factors that the impunity you are seeking will likely remain elusive. DW

We do not know what is the minimal amount of HIV hidden in a cluster of white blood cells needed to infect. And, to an extent, we can not know as



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